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How can weight affect fertility?

When women and couples who are experiencing difficulties with conception are overweight, they have generally already heard or read the advice that being overweight reduces their chance of falling pregnant. Seeing other women who have an equal or even greater problem with their weight, who have conceived successfully and are happily pushing their strollers down the street, only adds to the frustration and disappointment they are already feeling.

So how much of an impact does weight really have on conception and pregnancy, and for those who are struggling with their weight, can we help put this into perspective - successful conception and a safe pregnancy is certainly still possible.

How does weight impact my chances of having a baby?

Weight is an important consideration for both women and men in the preconception period. If you’re significantly overweight or underweight this can cause your body to produce more or less of the hormones that regulate ovulation in women and disrupt sperm production in men.

Weight gain in some women can be an indicator of a hormonal imbalance caused by a condition known as Polycystic Ovarian Syndrome (PCOS) - affecting both your ability to lose weight and disrupt regular ovulation. However not all women with PCOS are overweight.

Men who are significantly overweight generally have poorer sperm quality than those within a healthy weight range. Often, when a man is extremely overweight he will also have a reduced sex drive and erectile difficulties.

How do I know if I’m a healthy weight?

A common measure of weight is the Body Mass Index (BMI) which provides an index of your weight range in relation to your height. A healthy BMI is considered to be between 18.5 and 25.

Having a very high BMI (greater than 35) may decrease fertility rates in some circumstances and may also increase the risk of pregnancy related complications such as miscarriage, gestational diabetes and hypertension. As fertility specialists we understand that for many individuals BMI is not easy to change. However, as you can see from the effects, it is good to do as much as you can to improve your health.

The end result of a healthy lifestyle may not always be weight loss. Muscle build up (which is encouraged) can increase body weight. Striving to lose weight by following extreme diets is not sustainable and may be detrimental to a healthy pregnancy. Hence the focus should be on lifestyle modification not specifically weight loss. This philosophy equally applies to couples with normal BMIs – focus on general health and fitness, not just weight.

PCOS and Infertility

Polycystic Ovarian Syndrome (PCOS) is a hormonal condition that affects up to one in five women of reproductive age and can impact your ability to lose weight and ovulate. I see many women with PCOS where the condition causes insulin resistance, predisposing them to fat deposition and weight gain. This weight gain then contributes to increasing insulin levels, creating a self-perpetuating cycle.

The common symptoms of PCOS include:

Acne

Increased hair growth

Irregular or infrequent periods

Infertility

Weight gain and difficulty losing weight

How can we help women with PCOS have a baby?

Not all women with PCOS experience difficulty conceiving, although for those struggling there are ways we can manage the condition to help you conceive and go on to have a healthy pregnancy.

In addition to positive lifestyle changes through diet and exercise, medication such as Metformin, which is also used in the management of diabetes, can lower insulin levels to support weight loss.

If you are diagnosed as having PCOS and require additional support to induce ovulation, a simple fertility treatment such as Ovulation Induction (using medication such as Clomiphene and Letrozole) can help. If you do not respond to these oral medications, injectable medication (FSH injections) may be required.

For a small number of women with PCOS who don’t respond or respond excessively to ovulation inducing medication, we may recommend in-vitro fertilisation (IVF).

What if we are experiencing trouble becoming pregnant?

If you’re experiencing a delay in falling pregnant, a fertility specialist can help by offering a comprehensive medical assessment including understanding your medical history and conducting further tests. For the female, this might include an ultrasound scan to determine if a condition such as PCOS may be affecting your ability to conceive. If you are diagnosed with PCOS there are dedicated PCOS clinics that can help you manage non -fertility related symptoms.

As fertility specialists, we want to help as many couples as possible have their families, both successfully and safely. That includes providing you with empathetic support and medical care to enable you to reach your end goal of a healthy baby.

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The leading fertility clinics in the Virtus Health group, including IVF Australia, Melbourne IVF and Queensland Fertility Group, have joined forces to research sperm donation in Australia

What did we find out about Sperm Donation?

Only 20% of men are aware that there is a shortage of sperm donors in this country.

While the majority of Australians are aware of the need for blood and organ donation, the requirement for sperm donors is largely unknown.

Used by patients as either part of an In-Vitro Fertilisation (IVF) cycle, or via Intrauterine Insemination (IUI), donor sperm can help overcome male factor infertility (15%), or help same-sex couples (35%) and single women (50%) have a child.

What are the common motivations for donation?

The same research also discovered that the common reasons for wanting to donate sperm included:

Helping others to have a family (38%)

Knowing other people going through fertility treatment (24%)

Knowing my sperm count and quality could be assessed at donation (20%)

Everyone deserves to be a parent if they want to be (18%)

Sperm donors in Australia can be known to the recipient or recruited via the clinic. Many couples and individuals choose their sperm donor through a clinic, as knowing the demographic profile of the donor but not their identity is a preferred option. In these cases, children of sperm donors are able to access their biological father’s details when they are 18 years old.

While Australians cannot be paid for their sperm (like blood or organ donation) most clinics reimburse donors for legitimate expenses. Sperm donors in Australia are typically aged 25-45, with or without their own families, and of any sexual orientation.

Would you or someone you know now consider sperm donation?

After seeing the results of this research, we want to raise awareness of the need for more sperm donors in Australia. If it is something that you would consider talk to your local clinic for more information.

Sperm Donation in Australia Infographic

* Research conducted by Woolcott Research in March 2012.

UK scientists will examine the effects of a Mediterranean diet rich in omega-3 fish oil and vitamin D on fertility for women and couples undergoing In Vitro Fertilisation (IVF).

Common sense would suggest that preconception health of both women and men could play a role in the Assisted Reproductive Technology (ART) treatment outcome. We all know that a healthy lifestyle and good nutrition influences the quality of egg and sperm in the preconception period, therefore increasing the chances of a successful pregnancy.

What is a Mediterranean diet?

The Mediterranean style diet is high in fruits, vegetables, fish, wholegrain, nuts and seeds. It is limited in red meat, dairy, alcohol and processed foods such as cakes and mayonnaise2

More evidence of Mediterranean diet’s benefits

Omega-3 fatty acids are derived from oily fish sources such as salmon, mackerel and sardines, nuts and seeds. Omega-3 serves as a precursor to different prostaglandins (PGs) that are important in the menstrual cycle, growth and development of eggs and initiation of the ovulation. PGs also play a role in fertilization of the embryo in the uterus.2

Vitamin D is derived from dietary oily fish and eggs. It appears to impact IVF outcomes by boosting levels of progesterone and estrogen, which regulates menstrual cycles improving the chance of conception.

You may be thinking what about men? Vitamin D also benefits semen quality and count in males. Additionally, it increases levels of testosterone, boosting libido. 3

Current guidelines suggest to prescreen all women before IVF. Optimal vitamin D levels are considered to be 75m/mol or above. We commonly prescribe vitamin D doses ranging from 1000-5000iu a day. Dosage recommended in infertility depends on the blood levels. If you are very deficient it may be hard to obtain sufficient amounts of Vitamin D from the diet alone and supplements are highly recommended.4

But, do these positive results from dietary omega-3 and vitamin D, translate into positive results from supplementation?

The answer is we don’t know yet. Vitamins and minerals absorb more effectively from food sources. There are other co-factors in food that increase vitamin and nutrient activation in the body. Nevertheless, both omega-3 and vitamin D supplements have a low side effects profile and are safe before, during and after (breastfeeding stage) pregnancy.

One other likely benefit of the Mediterranean diet to fertility is its high vitamin B content. Vitamin B6 and B12, as well as Folate, is required to breakdown homocysteine, a naturally occurring amino acid found in blood plasma. Elevated levels of homocysteine are associated with adverse reproductive and pregnancy outcomes. This is why adequate intake of Folate, B6 and B12 is recommended for women who are trying to conceive either spontaneously or via IVF. In another blog I will discuss the significance of homocysteine pathway and its link to the quality of sperm and egg.2

What does this mean if you’re undergoing IVF?

Following a Mediterranean diet may increase your chances of achieving pregnancy through IVF. Omega-3 fatty acids and vitamin D play an important role though further research is still required to confirm this link.

Currently there are no specific guidelines on what constitutes a Mediterranean diet and optimal quantities of certain foods in order to make a routine recommendation. IVF patients may benefit from a nutrition assessment by a clinical dietitian or a naturopath who can review their dietary habits and develop a food plan.

In the case of Vitamin D, given the current prevalence of deficiency in sub-fertile women and men, and difficulty deriving enough from diet alone, supplementation alongside ART treatment may be recommended in most cases.

Has following a Mediterranean diet worked for you?

Many people use complementary or alternative therapies to improve their overall physical and emotional health. Some women also consider using these therapies to prepare their body for pregnancy or support them through fertility treatment.

Why are women turning to Acupuncture while undergoing IVF?

Acupuncture has grown in popularity in Australia as an adjunct to IVF treatment and is claimed to reduce stress, improve the quality of life while you’re undertaking treatment, and stimulate blood flow to the uterus influencing menstrual cycle and ovulation.

Some limited studies have shown that acupuncture on the day of embryo transfer, within an IVF cycle, may improve implantation rates although it should also be borne in mind that some recent studies have not found acupuncture to be effective.

Background on the current study into IVF and Acupuncture

The clinics within the Virtus Health group, including IVFAustralia, Melbourne IVF and Queensland Fertility Group, are continually investing in research projects that seek to improve health and reproductive outcomes for patients. In some cases this involves working together with complementary therapists to maximise patient fertility. An example of this is the relationships that have been setup between acupuncture clinics in Sydney’s Eastern Suburbs and the Bondi Junction IVFAustralia clinic.

A current research project that IVFAustralia and Melbourne IVF are involved in is a national multi-centre randomised controlled acupuncture trial in conjunction with The University of Western Sydney. The purpose is to formally investigate the effectiveness, or not, of acupuncture in improving the proportion of live birth rates for women undergoing in vitro fertilisation (IVF).

What are the expected outcomes of this trial?

This study will determine the cost effectiveness of IVF with acupuncture, assess the personal and social context of acupuncture on IVF patients and identify other effects of acupuncture.

It will add significant knowledge to defining the exact role of acupuncture in the management of IVF from a clinical and cost effectiveness perspective. Any way that we can reduce the number of cycles it takes for our patients to achieve a healthy pregnancy, is likely to have a positive emotional and financial impact on that family.

However, regardless of the outcome of this trial, while improving your general health and wellbeing is clearly beneficial, acupuncture is not for everyone and varied opinions reflect the limited evidence on its effectiveness.

Who is eligible to take part?

We are currently recruiting IVF Australia and Melbourne IVF patients interested in taking part in the trial.

To participate you must: be less than 43 years of age, be undergoing a fresh IVF or Intracystoplasmic sperm injection (ICSI) cycle; and not be undergoing a pre-implantation genetic diagnosis (PGD) cycle.

Participants in the trial will receive their treatments on the day of embryo transfer – administered by experienced acupuncturists – at research partnered IVF units in clinics across Australia.